System and method for cardiac rhythm management with synchronized pacing protection period

Abstract

A device and method for cardiac rhythm management in which a heart chamber is paced in accordance with a pacing mode that employs sense signals from the opposite chamber. A protection period triggered by the sensing of intrinsic activity in the paced chamber is used to inhibit pacing without otherwise disturbing the pacing algorithm.

1. A method for operating a cardiac rhythm management device, comprising:
 sensing a right ventricle and generating a right ventricular sense upon detection of depolarization occurring in the right ventricle; 
 sensing the left ventricle and generating a left ventricular sense upon detection of depolarization occurring in the left ventricle; 
 pacing the left and right ventricles in accordance with expiration of an escape interval, wherein the right ventricle is paced upon expiration of the escape interval and the left ventricle is paced at a pacing instant defined to occur prior to expiration of the escape interval by a specified offset interval; 
 restarting the escape interval after a right ventricular sense or pace, wherein the escape interval is unaffected by a left ventricular sense; and, 
 inhibiting the left ventricular pace if the pacing instant occurs within a protection period initiated by a left ventricular sense. 
 
   
   
     2. The method of  claim 1  wherein a protection period is also initiated by a left ventricular pace. 
   
   
     3. A method for operating a cardiac rhythm management device, comprising:
 sensing an atrium and generating an atrial sense upon detection of depolarization occurring in the atrium; 
 initiating an atrio-ventricular escape interval after an atrial sense; 
 sensing a right ventricle and generating a right ventricular sense upon detection of depolarization occurring in the right ventricle; 
 sensing the left ventricle and generating a left ventricular sense upon detection of depolarization occurring in the left ventricle; 
 pacing the left and right ventricles in accordance with expiration of the atrio-ventricular escape interval, wherein the right ventricle is paced upon expiration of the atrio-ventricular escape interval and the left ventricle is paced at a pacing instant defined to occur prior to expiration of the atrio-ventricular escape interval by a specified offset interval; 
 stopping the atrio-ventricular escape interval after a right ventricular sense, wherein the atrio-ventricular escape interval is unaffected by a left ventricular sense; and, 
 inhibiting the left ventricular pace if the pacing instant occurs within a protection period initiated by a left ventricular sense. 
 
   
   
     4. The method of  claim 3  further comprising initiating the atrio-ventricular escape interval after an atrial pace. 
   
   
     5. The method of  claim 3  wherein a protection period is also initiated by a left ventricular pace. 
   
   
     6. A method for operating a cardiac rhythm management device, comprising:
 sensing the right ventricle and generating a right ventricular sense upon detection of depolarization occurring in the right ventricle; 
 sensing the left ventricle and generating a left ventricular sense upon detection of depolarization occurring in the left ventricle; 
 pacing the left ventricle upon expiration of an escape interval; 
 restarting the escape interval after a right ventricular sense, wherein the escape interval is unaffected by a left ventricular sense; 
 restarting the escape interval after a left ventricular pace; and, 
 inhibiting the left ventricular pace if the pacing instant occurs within a protection period initiated by a left ventricular sense. 
 
   
   
     7. The method of  claim 6  wherein a protection period is also initiated by a left ventricular pace. 
   
   
     8. A method for operating a cardiac rhythm management device, comprising:
 sensing an atrium and generating an atrial sense upon detection of depolarization occurring in the atrium; 
 initiating an atrio-ventricular escape interval after an atrial sense; 
 sensing the right ventricle and generating a right ventricular sense upon detection of depolarization occurring in the right ventricle; 
 sensing the left ventricle and generating a left ventricular sense upon detection of depolarization occurring in the left ventricle; 
 pacing the left ventricle upon expiration of the atrio-ventricular escape interval; 
 stopping the atrio-ventricular escape interval upon occurrence of a right ventricular sense, wherein the atrio-ventricular escape interval is unaffected by a left ventricular sense; and, 
 inhibiting the left ventricular pace if the pacing instant occurs within a protection period initiated by a left ventricular sense. 
 
   
   
     9. The method of  claim 8  wherein a protection period is also initiated by a left ventricular pace. 
   
   
     10. The method of  claim 8  further comprising initiating the atrio-ventricular escape interval after an atrial pace. 
   
   
     11. A cardiac rhythm management device, comprising:
 circuitry for generating a right ventricular sense; 
 circuitry for generating a left ventricular sense; 
 circuitry for pacing the left and right ventricles in accordance with expiration of an escape interval, wherein the circuitry for pacing the left and right ventricles is configured such that the right ventricle is paced upon expiration of the escape interval and the left ventricle is paced at a pacing instant defined to occur prior to expiration of the escape interval by a specified offset interval; 
 circuitry for restarting the escape interval after a right ventricular sense or pace and leaving the atrio-ventricular escape interval unaffected by a left ventricular sense; and, 
 circuitry for inhibiting the left ventricular pace if the pacing instant occurs within a protection period initiated by a left ventricular sense. 
 
   
   
     12. The device of  claim 11  further comprising circuitry for initiating the protection period by a left ventricular pace. 
   
   
     13. A cardiac rhythm management device, comprising:
 circuitry for generating an atrial sense; 
 circuitry for initiating an atrio-ventricular escape interval after an atrial sense; 
 circuitry for generating a right ventricular sense; 
 circuitry for generating a left ventricular sense; 
 circuitry for pacing the left and right ventricles in accordance with expiration of the atrio-ventricular escape interval, wherein the circuitry for pacing the left and right ventricles is configured such that the right ventricle is paced upon expiration of the atrio-ventricular escape interval and the left ventricle is paced at a pacing instant defined to occur prior to expiration of the atrio-ventricular escape interval by a specified offset interval; 
 circuitry for stopping the atrio-ventricular escape interval after a right ventricular sense and leaving the atrio-ventricular escape interval unaffected by a left ventricular sense; and, 
 circuitry for inhibiting the left ventricular pace if the pacing instant occurs within a protection period initiated by a left ventricular sense. 
 
   
   
     14. The device of  claim 13  further comprising circuitry for initiating the atrio-ventricular escape interval after an atrial pace. 
   
   
     15. The device of  claim 13  further comprising circuitry for initiating the protection period by a left ventricular pace. 
   
   
     16. A cardiac rhythm management device, comprising:
 circuitry for generating a right ventricular sense; 
 circuitry for generating a left ventricular sense; 
 circuitry for pacing the left ventricle upon expiration of an escape interval; 
 circuitry for restarting the escape interval after a right ventricular sense and for leaving the escape interval unaffected by a left ventricular sense; 
 circuitry for restarting the escape interval after a left ventricular pace; and, 
 circuitry for inhibiting the left ventricular pace if the pacing instant occurs within a protection period initiated by a left ventricular sense. 
 
   
   
     17. The device of  claim 16  further comprising circuitry for initiating the protection period by a left ventricular pace. 
   
   
     18. A cardiac rhythm management device, comprising:
 circuitry for generating an atrial sense; 
 circuitry for initiating an atrio-ventricular escape interval after an atrial sense; 
 circuitry for generating a right ventricular sense; 
 circuitry for generating a left ventricular sense; 
 circuitry for pacing the left ventricle upon expiration of the atrio-ventricular escape interval; 
 circuitry for stopping the atrio-ventricular escape interval upon occurrence of a right ventricular sense and for leaving the atrio-ventricular escape interval unaffected by a left ventricular sense; and, 
 circuitry for inhibiting the left ventricular pace if the pacing instant occurs within a protection period initiated by a left ventricular sense. 
 
   
   
     19. The device of  claim 18  further comprising circuitry for initiating the protection period by a left ventricular pace. 
   
   
     20. The device of  claim 18  further comprising circuitry for initiating the atrio-ventricular escape interval after an atrial pace.